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Nulojix

belatacept
Used for Organ Transplant
Used for Organ Transplant

Nulojix (belatacept) is an immunosuppressant that works to prevent your body from rejecting a transplanted organ. This monthly infusion through the vein is FDA approved for adults who've had a kidney transplant only. Nulojix (belatacept) is typically given by a trained healthcare professional in a healthcare setting. Side effects can include anemia; swelling in the arms, legs, or feet; and changes in blood pressure. Nulojix (belatacept) is typically taken with other transplant medications to prevent organ rejection.

Reviewed by:
reviewer
Allison Gourley, PharmD
reviewer
Kristianne Hannemann, PharmD
Last reviewed on February 4, 2025
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsContraindicationsAlternativesReferencesPricesMedicare
basics-icon

What is Nulojix (belatacept)?

What is Nulojix (belatacept) used for?

How Nulojix (belatacept) works

Nulojix (belatacept) is a type of immunosuppressant called a selective T-cell costimulation blocker. It attaches to two spots on the surface of certain immune cells in your body. The medication stops T-cells from becoming active, recognizing your transplanted kidney as foreign, and attacking it. This helps prevent organ rejection.

Are you looking for information on Orencia (abatacept) instead?

Drug Facts

Common BrandsNulojix
Drug ClassImmunosuppressant
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Nulojix (belatacept)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Anemia (45%)
  • Diarrhea (39%)
  • Constipation (33%)
  • Urinary tract infection (37%)
  • Swelling in the arms, legs, or feet (34%)
  • High blood pressure (32%)
  • Fever (28%)
  • Cough (24%)
  • Vomiting (22%)
  • Headache (21%)

Other Side Effects

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Post-transplant lymphoproliferative disorder (PTLD): fever; night sweats; not feeling well; unplanned weight loss; lower appetite; swollen lymph node in the neck, armpit, or groin; unusual changes in mood or behavior; confusion; problems thinking; movement problems
  • Infection: fever, chills, muscle aches, change in appetite, vomiting, pain while urinating, weight loss, skin rash

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Abdominal or stomach pain

agitation

black, tarry stools

bladder pain

bloating or swelling of the face, arms, hands, lower legs, or feet

bloody or cloudy urine

blurred vision

bone pain

burning while urinating

chest pain

chills

coma

confusion

convulsions

cough or hoarseness

decreased frequency or amount of urine

decreased urine output

depression

difficult or labored breathing

difficult, burning, or painful urination

dizziness

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

drowsiness

dry mouth

fainting

fast or irregular heartbeat

fever

frequent urge to urinate

headache

hostility

inability to move the arms and legs

increased blood pressure

increased thirst

irritability

itching in other skin areas

lethargy

loss of appetite

loss of bladder control

lower back or side pain

mood or mental changes

muscle pain or cramps

muscle spasms (tetany) or twitching

nausea or vomiting

nervousness

numbness or tingling in the hands, feet, or lips

pale skin

pounding in the ears

rapid weight gain

scaling

shortness of breath

slow or fast heartbeat

sore throat

sores, ulcers, or white spots on the lips or in the mouth

stupor

sudden decrease in the amount of urine

sudden numbness and weakness in the arms and legs

sweating

swelling of the face, ankles, or hands

swollen glands

tightness in the chest

trembling

troubled breathing

troubled breathing with exertion

unusual bleeding or bruising

unusual tiredness or weakness

unusual weight gain or loss

weakness or heaviness of the legs

weight gain

wheezing

Less common

Back pain

coughing or spitting up blood

drowsiness

joint pain, stiffness, or swelling

loss of appetite

night sweats

persistent non-healing sore

pink growth reddish patch or irritated area

shiny bump

sudden high fever or low-grade fever for months

swelling of the feet or lower legs

weight gain

white, yellow, or waxy scar-like area

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Abdominal or stomach cramps

blemishes on the skin

body aches or pain

collection of blood under the skin

cough producing mucus

deep, dark purple bruise

diarrhea

difficulty having a bowel movement (stool)

difficulty with moving

dry mouth

ear congestion

flushed, dry skin

fruit-like breath odor

hair loss or thinning of the hair

increased hunger

increased sweating

increased urination

itching, pain, redness, or swelling

loss of consciousness

loss of voice

muscle cramps in the hands, arms, feet, legs, or face

muscle or bone pain

muscle pain or stiffness

numbness and tingling around the mouth, fingertips, or feet

pain in the joints

pimples

shakiness in the legs, arms, hands, or feet

shortness of breath

sleeplessness

sneezing

swelling or inflammation of the mouth

tightness in the chest

tremor

trouble sleeping

unable to sleep

unexplained weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Nulojix (belatacept)

thumbs-up

Pros

Given once a month (after a few starter doses)

Less likely to cause kidney damage than certain other transplant medications (e.g., calcineurin inhibitors)

thumbs-down

Cons

Only used for people who've been exposed to the Epstein-Barr virus (EBV)

Not approved for children 17 years and younger who've had a transplant

Not approved for people with other organ transplants; only for people who've had a kidney transplant

pharmacist-tips

Pharmacist tips for Nulojix (belatacept)

pharmacist

  • Before you start Nulojix (belatacept), let your transplant specialist know if you typically need to get poked more than once when you get any blood tests done. This could mean that it's tricky to find a vein that can be used easily for blood draws and infusions. It might make it more difficult for you to receive the Nulojix (belatacept) infusion through the vein.

    • Follow the dosing schedule that your transplant specialist gives you for your Nulojix (belatacept) infusions. Be sure to put your appointments in your calendar and set reminders for them. This will help you stay on track with your treatment.

      • Call your transplant team if you can't make it to your appointment for your Nulojix (belatacept) infusion or if you forget to go. At the beginning of treatment, your transplant specialist might need to adjust your dosing schedule. And once you can get your infusions monthly, it's okay if you get your infusion within 3 days (before or after) of your originally scheduled date. But you still need to reschedule.

        • Check your blood pressure at home often because Nulojix (belatacept) can cause changes to your blood pressure (can go up or down). Share the numbers with your transplant specialist and your primary care provider. Your prescriber might need to adjust the dose any blood pressure medications you might be taking.

          • Limit your time out in direct sunlight, wear protective clothing, and use sunblock when you're outside. Taking immunosuppressants like Nulojix (belatacept) can put you at risk for skin cancer. These are things you can do to help lower your risk.

            • Before you get any vaccines, tell the pharmacist or healthcare professional that you're taking Nulojix (belatacept). They can make sure it's safe for you to get the vaccine. This medication can change the way your immune system responds to vaccines. Avoid live vaccines, like the nasal spray flu vaccine, while you're taking this medication because you're at higher risk of getting sick from the the vaccine itself.

              faqs

              Frequently asked questions about Nulojix (belatacept)

              When was Nulojix (belatacept) approved by the FDA for transplant?
              Nulojix (belatacept) was approved by the FDA in 2011. It's approved for preventing organ rejection in adults who've received a kidney transplant.
              What cells are impacted by Nulojix (belatacept)?
              Nulojix (belatacept) affects how immune cells called T-cells work in the body. This medication stops T-cells from becoming active and recognizing your newly transplanted kidney as foreign. In turn, it stops the T-cells from attacking your transplanted kidney to help prevent organ rejection. Nulojix (belatacept) can also lower the number of red blood cells in the body and cause anemia as a side effect for some people.
              How long is a Nulojix (belatacept) infusion?
              The Nulojix (belatacept) infusion itself takes about half an hour. But also make sure to add some extra time just in case you need to fill out any forms at the medical center. After your first infusion, your transplant specialist or the healthcare professionals at the center might want you to stay for a little while longer. This is just to make sure you tolerate the medication and don't have a reaction to it.
              Does Nulojix (belatacept) cause hair loss?
              Although it isn't common, some people who've taken Nulojix (belatacept) have reported hair loss. In a couple of clinical studies, less than 10% of people who took the medication noticed hair loss over the span of 3 years. Talk with a healthcare professional if you experience hair loss while you're taking Nulojix (belatacept). They can help figure out what's causing your hair loss.
              Can Nulojix (belatacept) cause weight gain?
              Weight gain wasn't a side effect that people who received Nulojix (belatacept) reported during clinical studies. Let your transplant specialist know if you gain a large amount of weight. Since your dose of Nulojix (belatacept) is based on your weight, it's important for your prescriber to know about changes in weight. It's possible that your prescriber might need to adjust your dose based on your weight change.
              Can I receive my Nulojix (belatacept) infusion at home?
              Maybe. Most people receive their Nulojix (belatacept) infusion at a healthcare setting, like an infusion center. But some people have gotten their infusion at home. For these home infusions, the transplant specialist arranges for a nurse to come to your house to administer the medication. Speak with your transplant specialist about whether home infusions of Nulojix (belatacept) are possible for you.
              Why do I need to get tested for Epstein-Barr virus before I can take Nulojix (belatacept)?
              You'll need to get tested for Epstein-Barr virus (EBV) before you start Nulojix (belatacept) because it decides whether you can take the medication or not. Clinical studies suggest that people taking Nulojix (belatacept) who've never been exposed to EBV in the past are at higher risk for post-transplant lymphoproliferative disorder (PTLD) than those who've been exposed to the virus. PTLD is a serious complication that can happen even years after your transplant. People who've never been exposed to EBV (i.e., test negative for EBV) can't take Nulojix (belatacept) because of the high risk for PTLD. Talk to your transplant specialist if you have questions about EBV testing.
              Can I get Nulojix (belatacept) if I've had a liver, lung, or heart transplant?
              Nulojix (belatacept) is FDA approved only for people who've had a kidney transplant. It's not recommended for people with a liver transplant. They have a higher risk that the liver stops working and a higher risk of death. For people who've had a lung transplant, a small study showed that Nulojix (belatacept) might be helpful after trying other medications like tacrolimus (Prograf). But some people still had poor results. And some people who've had a heart transplant took Nulojix (belatacept) to avoid kidney damage that's possible with other transplant medications. These uses are off-label since Nulojix (belatacept) isn't FDA approved for people with lung or heart transplants. Talk to your transplant specialist if you've had a liver, lung, or heart transplant.
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              What are the risks and warnings for Nulojix (belatacept)?

              Nulojix (belatacept) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Must be under the care of an experienced transplant specialist

              An experienced transplant specialist will manage your treatment with Nulojix (belatacept). This is important because the medication weakens the immune system and puts you at risk for many serious complications. The care team will have the appropriate resources available to make sure your treatment is going well and is safe for you.

              risk-warning

              Post-transplant lymphoproliferative disorder (PTLD)

              • Risk factors: People who've never been exposed to Epstein-Barr virus | Have a cytomegalovirus (CMV) infection | T cell-depleting therapy | Taking higher-than-recommended or frequent doses of Nulojix (belatacept) | Taking higher-than-recommended doses of other immunosuppressants

                People treated with Nulojix (belatacept) have a greater risk for developing post-transplant lymphoproliferative disorder (PTLD) than those treated with cyclosporine. PTLD is a serious condition that can happen after your transplantation. It happens when your white blood cells multiply abnormally, which can potentially lead to lymphoma (a type of blood cancer).

                The risk for PTLD is even higher for people who don't have antibodies to Epstein-Barr virus (EBV) and for people who have a cytomegalovirus (CMV) infection. You're also at higher risk if you're receiving T cell-depleting therapies in the hospital to treat rejection.

                Contact your transplant specialist if you have fever, night sweats, unplanned weight loss, lower appetite, or changes in vision. Also let them know if you feel a swollen lymph node in the neck, armpit, or groin. Call your transplant specialist right away if you or your loved ones notice unusual changes in mood or behavior, confusion, or problems thinking. These all can be signs of PTLD.

                risk-warning

                Risk for cancer, including skin cancer

                People who take immunosuppressants like Nulojix (belatacept) are at higher risk of developing cancers, such as skin cancer. This is because these medications lower the ability of your body to fight cells that become abnormal.

                Lower your risk for skin cancer by limiting your exposure to sunlight and ultraviolet (UV) light. Also wear protective clothing and use sunblock when you're outside.

                risk-warning

                Serious infections

                • Risk factors: Taking other immunosuppressants | Taking higher-than-recommended and more frequent doses of Nulojix (belatacept)

                  Nulojix (belatacept) weakens your immune system. It can put you at risk of developing serious or life-threatening bacterial, fungal, and viral infections. During treatment, certain infections that you've had in the past, such as tuberculosis (TB), can come back. And sometimes, opportunistic infections (those that usually only cause problems when the immune system is weak) can develop and potentially lead to serious complications.

                  Before you start Nulojix (belatacept), your transplant specialist will examine you to check for any infections. Let them know if you have a history of frequent infections, infections that keep coming back, or any long-term infections. Your transplant specialist will talk with you about taking additional medications to protect against infection.

                  In general, avoid getting sick by trying to stay away from people who are ill. Wash your hands often. Call your transplant specialist right away if you develop symptoms of an infection, such as fever, chills, muscle aches, change in appetite, weight loss, vomiting, or pain while urinating.

                  risk-warning

                  Not recommended for people who've had a liver transplant

                  Nulojix (belatacept) isn't recommended and isn't FDA approved for people who've had a liver transplant. In a clinical study of people who had a liver transplant, those who received Nulojix (belatacept) had a higher risk for graft loss (losing their transplant) and death than those who received tacrolimus (Prograf). Your transplant specialist will discuss with you about safer transplant medications if you had a liver transplant.

                  risk-warning

                  Change in immune response to vaccines

                  Transplant medications like Nulojix (belatacept) can change the way your immune system responds to vaccines. Some vaccines might not work as well to protect you from infection. Avoid getting any live vaccines while you're taking this medication because your risk of getting sick from the vaccine itself is higher.

                  Always tell your healthcare professional or pharmacist that you're taking an immunosuppressant like Nulojix (belatacept) before you get vaccinated. They can let you know whether the shot you'd like to receive safe for you.

                  dosage

                  Nulojix (belatacept) dosage forms

                  Typical dosing for Nulojix (belatacept)

                  Nulojix (belatacept) is an intravenous (IV) infusion that's given through your vein. It's administered by a trained healthcare professional.

                  The dose depends on your body weight. In general, you'll follow a dosing schedule that your transplant specialist sets for you. The dosing schedule might look like the following.

                  Initial phase

                  • The typical dose is 10 mg/kg of body weight given IV:

                    • On day 1 (the day of your transplant)

                    • On day 5

                    • At the end of week 2 after transplantation

                    • At the end of week 4 after transplantation

                    • At the end of week 8 after transplantation

                    • At the end of week 12 after transplantation

                  Maintenance phase

                  • The typical dose is 5 mg/kg of body weight given IV:

                    • At the end of week 16 after transplantation

                    • Then, once every 4 weeks

                  interactions

                  Interactions between Nulojix (belatacept) and other drugs

                  Nulojix (belatacept) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Nulojix (belatacept). Please note that only the generic name of each medication is listed below.

                  Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                  Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                  contraindications-icon

                  Nulojix (belatacept) contraindications

                  Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Nulojix (belatacept) will not be safe for you to take.

                  • People who test negative for Epstein-Barr virus (EBV), meaning that they don't have antibodies to the virus in the body

                  • People with an unknown EBV status

                  alternatives

                  What are alternatives to Nulojix (belatacept)?

                  There are a number of medications that your doctor can prescribe in place of Nulojix (belatacept). Compare a few possible alternatives below.
                  Nulojix (belatacept)
                  Used for:
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                  Everolimus (Zortress)
                  Used for:
                  $115.94 Lowest GoodRx priceView Prices
                  Tacrolimus (Prograf)
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                  References

                  Best studies we found

                  Alasfar, S., et al. (2023). Current therapies in kidney transplant rejection. Journal of Clinical Medicine.

                  Archdeacon, P., et al. (2012). Summary of the US FDA approval of belatacept. American Journal of Transplantation.

                  Centers for Disease Control and Prevention. (2024). About Epstein-Barr virus (EBV).

                  View All References (16)

                  Centers for Disease Control and Prevention. (2024). Laboratory testing for Epstein-Barr virus (EBV).

                  Centers for Disease Control and Prevention. (2025). About cytomegalovirus.

                  E. R. Squibb & Sons, L.L.C. (2021). Nulojix- belatacept injection, powder, lyophilized, for solution [package insert]. DailyMed.

                  Iasella, C. J., et al. (2018). Maintenance belatacept-based immunosuppression in lung transplantation recipients who failed calcineurin inhibitors. Transplantation.

                  Issa, F., et al. (2010). Role of T cells in graft rejection and transplantation tolerance. Expert Review of Clinical Immunology.

                  Kou, T., et al. (2015). Belatacept treatment through home infusion as a safe and reasonable alternative to intitution-based treatment: A retrospective analysis of medical records. 2015 American Transplant Congress.

                  Launay, M., et al. (2019). Belatacept-based immunosuppression: A calcineurin inhibitor-sparing regimen in heart transplant recipients. American Journal of Transplantation.

                  Leukemia & Lymphoma Society. (n.d.). Lymphoma.

                  MedlinePlus. (2023). Transplant rejection.

                  Melvin, G., et al. (2012). Belatacept: A worthy alternative to cyclosporine? Journal of Pharmacology & Pharmacotherapeutics.

                  National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Kidney transplant.

                  National Kidney Foundation. (n.d.). Post-transplant lymphoproliferative disorder (PTLD).

                  National Kidney Foundation. (2024). Kidney transplant.

                  National Organization for Rare Disorders. (2018). Post-transplant lymphoproliferative disease.

                  Riccardi, N., et al. (2019). Definition of opportunistic infections in immunocompromised children on the basis of etiologies and clinical features: A summary for practical purposes. Current Pediatric Reviews.

                  Vincenti, F., et al. (2016). Belatacept and long-term outcomes in kidney transplantation. The New England Journal of Medicine.

                  GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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